Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

Propuesta de nuevas funcionalidades para la gestión de la Historia Clínica Electrónica en el sistema XAVIA HIS / New features proposal to the Electronic Health Record management in the XAVIA HIS system

La digitalización de la historia clínica, documento indispensable en la atención de salud y que posee carácter legal, es uno de los focos de atención en la e-Salud. El sistema XAVIA HIS compuesto por módulos que informatizan los procesos e interconectan las diferentes áreas de una institución hospitalaria, posee como atributo fundamental, una historia clínica electrónica única por paciente. Esta se compone por documentos basados en el estándar HL7-CDA. Sin embargo, el sistema XAVIA HIS presenta algunas limitantes en la interacción con otras aplicaciones que gestionen la información de salud. En el trabajo se presentan las modificaciones a realizar al Sistema de Información Hospitalaria XAVIA HIS para mejorar la capacidad de gestión de las historias clínicas electrónicas del sistema. Se realizó un análisis de la literatura disponible sobre la gestión de las HCE y se evaluó el mecanismo que emplean sistemas homólogos nacionales e internacionales. Para guiar el desarrollo de la propuesta se empleó la metodología AUP-UCI; UML se empleó para el modelado de los artefactos de ingeniería y BPMN como lenguaje de notación para los procesos de negocio. Las modificaciones que se presentan, le permitirán al sistema XAVIA HIS interactuar con sistemas externos que generen documentos HL7-CDA. Adicionalmente, se añaden funcionalidades para mejorar la impresión de documentos clínicos que se exportan, así como la generación de resúmenes de la historia clínica(AU)

One of the e-Health approaches is the digitalization of the medical record, an essential document in health care and with a legal character. The XAVIA HIS system, made up of modules to manage the processes and interconnect the different areas of a hospital institution, has as a fundamental attribute, a unique electronic medical record per patient. It is made up of documents based on the HL7-CDA standard. However, the XAVIA HIS system presents some limitations to interaction with other applications also managing health information. This paper presents the new features and changes to be made to the Hospital Information System XAVIA HIS to improve the electronic medical records management of the mentioned system. An analysis of the available literature on EHR management was carried out and the mechanism used by national and international counterpart systems was evaluated. To guide the development of the proposal, the AUP-UCI methodology was used; UML was used for modeling the engineering artifacts and BPMN as a notation language for business processes. The modifications that are presented will allow the XAVIA HIS system to interact with external systems which also generate HL7-CDA documents. Additionally, functionalities are added to improve the printing of clinical documents that are exported, as well as the generation of summaries of the medical record(AU)

Estrutura e processo de trabalho para implantação da teleconsulta médica no Sistema Único de Saúde do Brasil, um estudo transversal com dados de 2017-2018 / Estructura y proceso de trabajo para implantar la teleconsulta médica en el Sistema de Salud Único en Brasil, un estudio transversal con datos de 2017-2018 / Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data

Objetivo: Comparar estrutura e processo de trabalho na Atenção Básica para implantação da teleconsulta médica em municípios de diferentes regiões e portes populacionais (mil habitantes: <25; 25-100; >100). Métodos: Estudo transversal, com análise descritiva e bivariada, sobre dados de 2017-2018, para avaliar disponibilidade de computador com internet, câmera, microfone e caixa de som, e processo de trabalho das equipes (utilizar Telessaúde, central de regulação e fluxo de comunicação). Resultados: Analisadas 30.346 UBS e 38.865 equipes, a presença de equipamentos para teleconsulta entre UBS variou de 1,2% em municípios grandes do Norte a 26,7% em municípios pequenos do Sul. O processo de trabalho variou de 10,7% em municípios pequenos do Norte a 39,5% em municípios grandes do Sul. Comparados ao Sul, municípios médios do Norte (OR=0,14 - IC95% 0,11;0,17) e do Nordeste (OR=0,21 - IC95% 0,18;0,25) tiveram menores chances de dispor dos equipamentos necessários. Conclusão: Significativas desigualdades regionais recomendam investimentos em Saúde Digital.

Objetivo: Comparar estructura y proceso de trabajo en atención primaria para implementar la teleconsulta médica en municipios de diferentes regiones y tamaños (mil habitantes: <25; 25-100; >100). Métodos: Estudio transversal, con análisis descriptivo y bivariado, datos de 2017-2018 para evaluar la disponibilidad de computadora con internet, cámara, micrófono, altavoz y proceso de trabajo (uso de Telesalud, centro de regulación central y flujo de comunicación). Resultados: Se analizaron 30.346 unidades y 38.865 grupos. La presencia de equipos de teleconsulta osciló entre 1,2% en los grandes municipios del Norte y 26,7% en pequeños municipios del Sur. El proceso de trabajo osciló entre 10,7% en pequeños municipios del Norte y 39,5% en grandes municipios del Sur. En comparación con el Sur, municipios medianos del Norte (OR=0,14 - IC95% 0,11;0,17) y Nordeste (OR=0,21 - IC95% 0,18;0,25) tenían menos probabilidades de contar con los equipos necesarios. Conclusión: Existe la necesidad de inversiones en Salud Digital, con desigualdades regionales relevantes.

Objective: To compare the structure and the work process in Primary Care for implementing medical teleconsultation in municipalities in different regions and with different population sizes (<25,000; 25,000-100,000; >100,000 inhabitants). Methods: Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of computers with internet access, webcam, microphone, speaker, as well as to assess the work processes (use of Telehealth, service supply and demand control center, and communication flow). Results: 30,346 primary health centers and 38,865 teams were evaluated. Presence of teleconsultation equipment in the health centers ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. Established work process ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium-sized municipalities in the North (OR=0.14 - 95%CI 0.11;0.17) and Northeast (OR=0.21 - 95%CI 0.18;0.25) regions were less likely to have the necessary equipment. Conclusion: Significant regional inequalities call for investments in Digital Health.

Telehealth actions in times of COVID-19: information with evidence

SUMMARY The coronavirus pandemic (COVID-19) brought up discussions about improvements in both primary healthcare and hospital care in Brasil. In addition, the use of information and communication technology tools has become more prominent in the transmission of health information to patients remotely. Through content dissemination actions for professionals and direct guidance to users, remote telehealth/telemedicine services offer qualified actions that can reduce unnecessary referrals and decrease the flow of patients in health units. Information and communication technologies are allies in the fight against COVID-19.

El estado de la digitalización de América Latina frente a la pandemia del COVID-19: observatorio CAF del ecosistema digital / The state of digitalization in Latin America facing the COVID-19 pandemic: CAF observatory of digital ecosystem

La pandemia del COVID-19 es inusitada en la medida de que plantea un desafío al sistema socio-económico mundial. A partir de la aplicación de las primeras medidas sanitarias, sumadas al temor por el contagio, comenzaron a acumularse las evidencias anecdóticas que daban cuenta de la importancia de las tecnologías digitales para contrarrestar el aislamiento, difundir medidas profilácticas, y facilitar el funcionamiento de sistemas económicos. El propósito de este trabajo es estimar con base a la evidencia empírica la importancia de la digitalización como factor mitigante de la disrupción de la pandemia, así como evaluar cómo está América Latina posicionada para enfrentar este desafío

Posibilidades y limitaciones de la tele-estomatología / Possibilities and limitations of teledentistry

ABSTRACT Dental care is considered to be an example of complex manual interventions in the medical sector. The vision presented describes the organization of dental care based on the application of modern telecommunication technologies. In developed countries, general dental practitioners have a positive attitude toward incorporating teledentistry into their practice. In PubMed there is a tendency to increase the states by telehealth key words and tags, including teledentistry. Those health care tendencies show a steady trend toward the broadening of teledentistry services(AU)

RESUMEN El cuidado dental se considera un ejemplo de intervenciones manuales complejas en la industria médica. La visión presentada describe la organización de la atención dental basada en la aplicación de las modernas tecnologías de telecomunicación. En los países avanzados, los odontólogos generales tienen una actitud positiva ante la idea de introducir la teledentistería en su práctica. En PubMed hay una tendencia a aumentar los estados por las palabras clave y las etiquetas de la telesalud, incluida la teledentistería. Esas tendencias en materia de atención de la salud muestran una tendencia constante a la ampliación de los servicios de teledentistería(AU)

Aplicación de tecnologías disruptivas en telemedicina para la cobertura universal de servicios de salud / Application of disruptive technologies in telemedicine for universal coverage of health services

La aplicación de tecnologías disruptivas en telemedicina facilita la accesibilidad a tecnologías diagnósticas de poblaciones remotas sin acceso a especialistas y mejora la cobertura universal de servicios de salud. Este estudio realizado por la Unidad de Telemedicina del Ministerio de Salud Pública y Bienestar Social (MSPBS) en colaboración con el Dpto. de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias (IICS-UNA) sirvió para evaluar la utilidad de aplicaciones de tecnologías disruptivas en telemedicina para la cobertura universal de servicios de salud. Para el efecto se analizaron los resultados obtenidos por la red de telediagnóstico implementado en 67 hospitales del MSPBS. En dicho sentido se analizaron 540.397 diagnósticos remotos realizados entre enero del 2014 y septiembre de 2019. Del total, el 33,174 % (179.274) correspondieron a estudios de tomografía, 64,825 % (350.313) a electrocardiografía (ECG), 1,997 % (10.791) a electroencefalografía (EEG) y 0,004 % (19) a ecografía. La concordancia entre el diagnostico remoto y el diagnóstico "cara a cara" fue del 95 %. Con el diagnostico remoto se logró una reducción del coste que supone un beneficio importante para cada ciudadano del interior del país. Los resultados obtenidos evidencian que la aplicación de tecnologías disruptivas en telemedicina puede contribuir para la cobertura universal de servicios con tecnologías diagnósticas, maximizando el tiempo y productividad del profesional, aumentando el acceso y la equidad, y disminuyendo los costos. Sin embargo antes de su implementación generalizada se deberá contextualizar con el perfil epidemiológico regional. Palabras claves: tecnología disruptiva, aplicación, tecnología diagnóstica, telemedicina, cobertura universal, servicios de salud, innovación tecnológica.

Introduction: The application of disruptive technologies in telemedicine facilitates accessibility to diagnostic technologies of remote populations without access to specialists and improves universal coverage of health services. This study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Institute of Research in Sciences (IICS-UNA). Objective: to evaluate the usefulness of disruptive technology applications in telemedicine for universal coverage of health services January 2014 to September 2019. Material and Method: observational and descriptive design study included 540,397 patients. For this purpose, the results obtained by the telediagnostic network implemented in 67 MSPBS hospitals were analyzed. In this regard, 540,397 remote diagnoses carried out between January 2014 and September 2019 were analysed. Results: of the total, 33.174% (179,274) were CT studies, 64.825% (350,313) electrocardiography (ECG), 1.997% (10,791) electroencephalography (EEG) and 0.004% (19) ultrasound. The concordance between remote diagnosis and "face-to-face" diagnosis was 95%. Conclusion: remote diagnosis achieved a cost reduction that is an important benefit for every citizen of the interior of the country. The results show that the application of disruptive technologies in telemedicine can contribute to the universal coverage of services with diagnostic technologies, maximizing the time and productivity of the professional, increasing access and equity, and lowering costs. However, prior to widespread implementation, the regional epidemiological profile should be contextualized. Keywords: Disruptive technology, application, diagnostic technology, telemedicine, universal coverage, health services, technological innovation.

Astronomia no Império brasileiro: longitude, congresso internacional e a busca por uma ciência universal no final do século XIX / Astronomy in the Brazilian Empire: longitude, an international congress and the quest for a universal science in the late nineteenth century

Resumo Não há uma visão clara na historiografia internacional sobre a participação do Brasil na Conferência de Washington de 1884. No Brasil há uma interpretação de que o voto brasileiro acompanhou a França, por razões de subordinação. Este texto pretende estabelecer um diálogo com essas produções, ao trazer fontes inéditas sobre o tema, como as cartas trocadas por Luiz Cruls, tanto com o imperador como com sua esposa, bem como notícias de periódicos, anais e relatórios. Neste artigo foi utilizada uma abordagem da história da ciência, preocupada com os processos de institucionalização da astronomia no Brasil em meio a um debate mundial sobre padronização e universalização da ciência.

Abstract There is no clear picture in the international historiography of Brazil's participation at the International Prime Meridian Conference in Washington of 1884. In Brazil there exists the prevailing interpretation that the Brazilian vote accompanied France for reasons of subordination. This work seeks to analyze this interpretation, by scrutinizing unpublished sources on the subject, such as the letters exchanged by Luiz Cruls both with the emperor and with his wife, as well as news articles in journals, annals and reports. In this article, an approach to the history of science was adopted that was concerned with the processes of institutionalization of astronomy in Brazil in the midst of a worldwide debate on the standardization and universalization of science.